A growing market
In an August news release
announcing the Persona IQ implant, Zimmer Biomet President and CEO Bryan Hanson said the company had expanded its partnership with Canary Medical and expects the smart knee to be “the first in a broader portfolio of smart implant technologies in various orthopedic surgery applications.”
The two companies are exploring adding sensors to other knee implants, as well as hip and shoulder implants, according to Dr. Bill Hunter, a founder and CEO of Canary Medical.
The Zimmer Biomet-Canary Medical partnership is just one of the smart implant efforts in the orthopedic device market.
Canary Medical, separately from Zimmer Biomet, is also working on smart screws for spinal procedures. Stryker, another devicemaker, this year acquired OrthoSensor, a company that develops sensors for total joint replacement—which Stryker at the time said could support work toward adding wearables and smart implants to its joint replacement business.
Stryker declined an interview request from Modern Healthcare.
Some of the metrics that smart implants would track—like step count—can be monitored with other, less invasive technologies, such as wearable fitness trackers. Previous studies have suggested step counts tracked with wearables can be used to predict length of stay after various surgeries, including hip replacements.
“Wearables are seeing an amazing renaissance,” said Glenn Snyder, who leads the medical technology practice at Deloitte.
But while “wearable sensors have amazing potential … in the end, it’s all dependent on the individual to wear them,” Snyder said.
Implantable devices don’t have that same compliance roadblock. With Zimmer Biomet’s smart knee, a patient’s data will be passively collected as long as they keep the base station in their home turned on and connected to the internet.
DePuy Synthes, the orthopedics arm of Johnson & Johnson’s medical devices group, is also working on making its products more digitally connected as part of a push toward personalized care. A year and a half ago, DePuy Synthes launched a brand called Velys focused on bringing digital technology to surgery, with plans to add pre-op and post-op tools.
“That journey is now something that needs to be tied together,” said I.V. Hall, vice president of research and development for robotics, digital solutions and capital equipment at DePuy Synthes. “It’s not just the implant instrument anymore. It’s how the patient is recovering and how the patient is actually preparing for that surgery.”
DePuy Synthes’ portfolio of digital technologies could one day include smart implants too. The company is looking into products incorporating sensors that collect patient data and has R&D teams focused on investigating sensor technologies like wearables and smart implants, according to Hall.
As an example, Hall said a smart implant could potentially help track whether a patient with a bone fracture is healing as expected.
“Our focus is on really putting data-driven insights into the system,” Hall said. “But we want to make sure that we’re collecting the right data—we’re collecting data that answers the questions that the surgeon has or solving a question around unmet needs.”
“It’s not just the implant instrument anymore. It’s how the patient is recovering and how the patient is actually preparing for that surgery.”
SUE MACINNES: What was your involvement in supply chain during COVID?
JOHNESE SPISSO: UCLA Health is one of the largest health systems in Los Angeles, so we tried to share supplies and support other hospitals in the community that were in need. One of the things that we initially did is we leased a huge warehouse in Van Nuys, California, and we began exploring direct contracts with international suppliers. We are part of a great group purchasing organization that many of you belong to as well and we were getting the vast majority of our supplies there, but we wanted to be as prepared as possible for surges. We were also helping to support other hospitals in Los Angeles. We were coordinating very closely with L.A. County and others so that we could distribute to areas of need.
DR. STEPHEN KLASKO: From the point of view of supply chain and the pandemic: two things. Some of it was luck and some of it was mission. We had become one of the centers post-Ebola for pandemic preparedness. We had 60 days of full personal protective equipment (PPE) and N95s, so that gave us a head start. That was the first thing. The second thing, we just got into a radical collaboration mode, both internally and externally. Pre-pandemic, every one of the places we had acquired or merged with was protective of their parochial medical staff bylaws. The moment the pandemic hit, they suspended all their bylaw arguments. We were sharing ventilators. And then finally we had our mission, vision and values. Do the right thing, put people first and be bold and think different.
DR. ALAN KAPLAN: I hadn’t been directly involved with supply chain since 2008. We set up our command center and a primary goal was to acquire adequate PPE, which was a big supply chain issue for all of us — keep our staff and patients safe, period. Absent a dependable purchasing source, we decreased utilization to extend the life of our very limited supply. Simultaneously, we focused on procurement. Procurement was nearly impossible. We explored domestic and international sources while also avoiding fraud, which was pervasive in the PPE market at that time. With the University of Wisconsin as our partner, we were able to use their 3D printing capability to produce PPE and spare parts. Throughout this time, we stayed in communication with our neighboring hospitals. If there was a segment of PPE that we could sufficiently supply, we provided assistance to neighboring hospitals. In fact, one of our community hospitals said without us academic types, they would not have been able to keep up with the ever-changing CDC recommendations related to PPE use or adequacy of supply.
MACINNES: What changes are you making now in regards to supply chain and what were the takeaways?
DR. RICHARD ISAACS: We could write a book on prioritization and distribution of supplies during a pandemic with increased global demand and diminishing resources. So that’s why we were front and center on supply chain issues. I took a very active role and connected with CEOs and other manufacturers, developing distribution and recycling approaches. I think telehealth was the biggest success story for Kaiser Permanente. Early on, patients couldn’t come in, and they needed us more than ever. So, we rapidly transformed how we practice medicine, particularly in terms of implementing our video care-first strategy. And it was unbelievable how our doctors and patients really embraced it. In Northern California, our
We learned a tremendous amount about speed to execution. COVID-19 gave us the impetus for rapid change.” DR. RICHARD ISSACS
physicians conducted nearly 3.7 million video visits in 10 months in 2020, which was astronomical compared to what we were doing pre-COVID, when we did about 100,000 visits in 2019. We also made it a priority to train physicians on the etiquette of a video visit because it’s important that our physicians show up just as well during video visits with patients as they do during inperson office visits. Of course, it’s not video care only now; it’s a hybrid approach. Our focus is determining where video care adds value, not only in primary care but for all our specialty care. And now, we have every department chair focusing in on what is the appropriate utilization of telehealth and mix with face-to-face visits so that we can take what we have learned over the past 20 months and move forward.
DR. JEFFREY COHEN: Innovation and speed became very important. As part of this, around 2017 we started exploring the use of an E-ICU with the Mercy health system in St. Louis. Now we can utilize ICU beds at the top of their license. Instead of having 125 beds at Allegheny General Hospital, we had 250 beds and they were all in use. And then we started running out of those resources. So, we figured out how to do this on a tablet and Highmark paid for us to acquire another 100 tablets and hook them into a Wi-Fi system. We went up to about 400 ICU beds literally in a week.
One other thing. As a policy, nobody got laid off and everybody got paid. And that’s great for the people that are there, but these institutions have responsibilities to their communities (to offer) that reassurance in a crisis. If the biggest institutional elements of the healthcare system say, ‘You’re all getting paid, don’t worry, we got this,’ it just calms the community down. That is leadership.
MACINNES: How can we improve the impact that we’re having on patients and address supply availability, social determinants of health, food deserts, education, to get better patient engagement and outcomes?
SPISSO: Los Angeles is in a county of 10 million people so our potential to overwhelm the health system was high. Additionally, L.A. is one of the most diverse communities in the country with health disparities that were evident pre-pandemic, so we knew there would be populations at higher risk for negative outcomes. As we approached this pandemic, our goal was to continue to operate full service for our community. We began quickly evaluating what I call the three S’s: staff, supply and surge capacity. Do we have the staffing needed for this? And are the staff trained to deal with this emerging pandemic? Do we have the supplies that we need to serve the community, and do we have the surge capacity to rapidly expand inpatient beds? We were able to quickly launch our disaster command center to address these issues. We also partnered with our federally qualified health center, the Venice Family Clinic, which is staffed by UCLA employees, to provide testing and ultimately vaccines to patients experiencing homelessness and other vulnerable populations.
We were also able to redeploy staff to set up drivethru testing centers in the community and screeners at entrances of all locations. This helped us in preventing layoffs of any staff within UCLA Health. We were one of the first health systems in California to be able to immediately perform COVID-19 testing in our laboratories which was a great asset that we shared with the community.
KLASKO: A lot of people always ask, what did the pandemic teach you? And I think when it comes to health equity, it didn’t teach us anything. It showed us what we already knew. We started talking about the “pan-didn’t,” like I didn’t get my mammogram. And we
As a policy, nobody got laid off and
everybody got paid. And that’s great for the people that are there, but these institutions have responsibilities to their communities (to offer) that reassurance in a crisis. DR. JEFFREY COHEN
Now I question everything we do. We’re now taking new approaches. We can encourage people with upper respiratory symptoms to start with a telehealth visit. DR. ALAN KAPLAN
recognize that a lot of the deaths that were attributed to COVID were probably people with chest pain that were afraid to come to the ED. We started a whole task force to look at the “pan-didn’t,“which could be more lethal than the pandemic.
And then we have a model called, Healthcare at Any Address. We really started to go out into the community. A good example of that is when the vaccine situation started, we did something called #realtalk where we partnered with African American and Latino pastors. And instead of explaining a lot what we were doing, we tried to understand what the hesitancy was and listen, and it was really fascinating.
MACINNES: When COVID happened, I never saw so much rapid action in my life. Could this be healthcare? How do you sustain that? How can we not go backwards and take this as a movement to advance healthcare forward quicker?
SPISSO: As I reflect back, now that we are almost two years since the start of COVID, the pandemic really helped us improve the organizational readiness and responsiveness. Additionally, we saw the emergence of unique partnerships with public health, with state and federal regulatory agencies, with our hospital regulatory agencies that allowed us to really communicate effectively and secure waivers and regulatory relief in areas that we needed to rapidly bring on surge capacity. And so, opening up that dialogue, I think increased their understanding of the burdens on hospitals, really on what we have to do to keep our patients safe and keep our staff safe. So we’re all feeling a little better about those communication pathways.
Additionally, with everything that was happening with the major social injustices we were seeing during this time, it also helped us to take a better look at what was happening in our community. And for us, it was really seeing how much more opportunity there was to better serve our community.
KAPLAN: It’s changed how I think about everything. I’m questioning everything we ever did. Back when I practiced emergency medicine, my personal mantra was, I’ll take care of any patient anywhere, anytime, for anything. If people felt ill and called our triage line, I would encourage them to come to the emergency department. I was more than willing to see them and provide care. Now that I think about this, what was I telling them? I was saying, ‘OK, it is clear you have an infectious disease, I’m going to invite you in to infect all my patients, my nurses, my fellow doctors, me, probably my kids and my wife.’ And that was what we did. Now I question, why did we ever do that? Why do we do that now? So, now I question everything we do. We’re now taking new approaches. We can encourage people with upper respiratory symptoms to start with a telehealth visit. Testing can be done in drive-thru facilities and patients that need to be seen can be seen in care settings separated from other patients.
ISAACS: We learned a tremendous amount about speed to execution. COVID-19 gave us the impetus for rapid change. It’s about looking at the status quo and asking, why are we doing things that way? What are the appropriate ways to transform and disrupt that? I developed an entire department for continuous process improvement, so we have all the right experts at the right place at the right time and drive all the downstream efficiency. But, how do you lead through the fatigue? That’s what keeps me up at night right now and we have developed resiliency programs, peer-to-peer support systems, and a focus to leverage technology and our integration.